The Importance of Evidence-Based Practice in Sex Education

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By Tori Culler, senior Social Work student at Appalachian State University

You may have heard it once or twice: the United States has one of the highest teen pregnancy rates among the developed nations. And you may not be surprised to learn that young people in the United States account for half of all new STD diagnoses each year – despite the fact that they only account for a quarter of the sexually active population.

The impacts of teen pregnancy and STD transmission among youth are far reaching. Poor outcomes in education, income, and overall health for teen parents and their children are just a few of the consequences. What’s more is that social stigmas associated with teen pregnancy and STDs make it hard for young people to overcome these obstacles, while annual costs to the public remain in the billions.

The intuitive solution to a problem of this scope is to examine and fundamentally reform the nation’s approach to school-based sex education, right? It’s not a new idea; one that has, in fact, sparked a heated debate in the United States for decades.

At its most basic level, the debate has centered on the division between abstinence-only and comprehensive sex education. Abstinence-only advocates promote a sex education curriculum that presents refraining from all sexual activity outside of marriage as the only effective way to prevent unwanted pregnancy and STDs. Comprehensive advocates promote a curriculum that presents multiple strategies beyond abstinence, such as proper contraceptive use. Both sides cling to their convictions, convinced that their way is the best way and should inform social policy.

While values and morals certainly have their place in political discourse, should the impetus for action not be more strongly grounded in logic and evidence?

Evidence-based practice is an ethical precept for nearly every profession, and it holds a particular importance within any human-services field – such as public health education. The concept is simple: constantly drawing upon an ever expanding database of knowledge, future procedures/programs/interventions should use only the elements that have been proven to work. Such a framework sets the stage for constant revision and improvement of services, recognizing that when something is broken, it should be fixed. For any issue, utilizing what works is the only way to garner the desired results.

When it comes to sex education, a large body of research exists on both abstinence-only and comprehensive programs. Trends in the research indicate that abstinence-only (AO) sex education does not work. Students who receive AO education are no more likely to remain abstinent than their peers who do not receive an AO education, with some studies indicating that they are also less likely to use contraception when they do have sex. The research favors comprehensive curricula, which leads to consistent contraceptive use and results in fewer teen pregnancies. Neither type of program has resulted in significantly improved STD transmission rates, indicating that there is still great room for improvement within sex education as a whole.

Despite the evidence, the United States government has a long history of funding abstinence-only education. Federal dollars were first allocated to AO education under the Reagan administration in 1981 and funding continues today under the Affordable Care Act. Between 1996 and 2010 alone, over $1.5 billion tax dollars were funneled into ineffective abstinence-only education.

The U.S. didn’t allocate federal funding streams for comprehensive education until the implementation of Obama’s Teen Pregnancy Prevention Initiative in 2010. This initiative provides grants to comprehensive sex education programs, emphasizing the importance of evidence-based practice and consistent, rigorous evaluation of such programs. While this is certainly a step in the right direction, the initiative is not widespread enough to nullify the continued funding of abstinence-only programs.

The evidence is clear: abstinence-only sex education does not improve the issue it was designed to address. Further, public opinion polls indicate that the vast majority of American citizens across a wide array of demographics support comprehensive sex education. Regardless of religious or political affiliation, more than 8 in 10 parents believe that comprehensive sex education is the way to go. It would therefore seem that the continued federal support for AO education is unjustifiable from every angle. Why, then, is it still supported?

The answer lies in political rhetoric and strategy that places control over sex education curricula in the hands of a vocal and extreme conservative minority. At the legislative level, it is this powerful minority who desire to see a strict, uniform abstinence-only-until-marriage policy that aligns with their personal value system that continue to prevail at the expense of young-people nationwide.

There must be an appeal to reason here: we cannot continue to use a strategy we know doesn’t work and expect different results. Personal values and philosophies should not distract from the goal at hand, which is to provide a healthy future for the coming generations. This should serve as a call to action for advocates who understand that sex education policy should rely on evidence-based principles in order to achieve reproductive justice for the nation’s youth. Those who are passionate about seeing positive and effective change in the arena of sex education must realize their potential for working across political differences to become a force for change.


 

This post is part of NARAL Pro-Choice North Carolina’s Student Perspectives on Reproductive Justice blog series. To write a post for the series, please contact our Advocacy & Organizing Manager at Sarah@ProChoiceNC.org.

Environmentalism & Feminism: The Undeniable Link Between Environmental Rights & Women’s Rights

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By Leah Block, first-year student at North Carolina State University

People look at me funny when I say I’m trying to find a career that incorporates both environmentalism and women’s rights. To me, the connection has always been so clear; if women are empowered, the environment will thrive. For one, the world-wide annual carbon footprint now averages 4 tons of carbon dioxide (CO2) per person per year, and the average annual carbon footprint in industrialized nations is a whopping 11 tons of CO2 per person per year . Women play a key role in population control, and therefore a key role in the mitigation of these statistics.

There are many ways to go about women’s empowerment, but when it comes to climate change, the most important step is giving women proper access to education. When girls go to school, not only do they learn about family planning skills, they are also far more likely to go into the working world. This puts off child-bearing for a number of years, and lowers the average size of families.

Another important step in the empowerment of women is one that’s a little more complicated due to cultural differences and expenses. Ensuring access to reproductive health – that is, access to birth control, contraceptives, and abortion care – is critical in reducing the average family size. In some developing countries, the average family includes 6 to 8 children. If we look at our average carbon footprint per person, 4 tons of CO2 per year, a family of 8 would produce 32 tons of CO2 per year. This astonishingly high statistic could be prevented simply by assuring that women in developing countries have access to condoms, birth control pills, or IUDs. Certain organizations such as Ipas work to ensure that women in developing countries have these rights, which is a great step towards a more stable environment for us all. 

A less discussed factor on this topic is the fact that women are responsible for most of the global farm work. In general, food production can be sustainable; unfortunately, food production in both developed and developing countries tends to be on the unsustainable side. A good example of poor agricultural practice is the deforestation of humid and semi-humid tropical rainforests, which are the world’s largest biomass reservoir. In fact, rainforests absorb about 8.8 billion tonnes of CO2 every year, making them a crucial component to Earth’s well-being. Farmers, many of them being women, clear-cut these forests to make room for new crops and pastures after “using up” land; that is, after depleting the soil of its nutrients. Going into countries where unsustainable practices are happening and reaching out to the women who manage food production is vital to the reduction of CO2 emissions, and therefore mitigating the effects of global climate change. Some sustainable tactics to teach these women include crop rotation, cover crops, soil enrichment, and Biointensive Integrated Pest Management.

Undoubtedly, when women receive proper care, the Earth receives proper care. The people who do not see an overlap between women’s rights and the well-being of Earth need to look a little closer. I am confident that I will create a career for myself which involves my two passions and betters the world in the long-run.


 

This post is part of NARAL Pro-Choice North Carolina’s Student Perspectives on Reproductive Justice blog series. To write a post for the series, please contact our Advocacy & Organizing Manager at Sarah@ProChoiceNC.org.

Reflecting on a Semester with NARAL Pro-Choice NC

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By Abby Kaufmann, NARAL Pro-Choice North Carolina Communications & Development Intern and senior at UNC Chapel Hill

When I accepted the position of Communication and Development Intern at NARAL Pro-Choice North Carolina, I wasn’t sure what to expect. I’ve known what the organization was for years because my mom was always very open about issues surrounding reproductive rights while I was growing up. From my understanding, they were a non-profit that dealt with things related to abortion. I had no idea that in addition to being a traditional non-profit, they not only have a foundation dedicated to research, education, and outreach but also work to influence policymakers to defend our state against anti-abortion attacks and promote policy that supports reproductive rights.

I knew that my internship would primarily deal with social media but was skeptical that there could be enough new information to share everyday. Boy was I wrong! Every day, I read and researched various articles relating to reproductive rights for our state affiliate to share. Plus, after realizing how important it was to stay up-to-date on social and political issues in this line of work, I subscribed to daily newsletters and frequently found my own articles to share. Working as an intern for NARAL Pro-Choice North Carolina encouraged me to stay informed on current events and allowed me to see ways in which certain topics intersect that I never would have even considered before. I realized how interconnected reproductive rights are with various social, political, and economic problems that exist in our world today.

When I first started, one of my supervisors explained that, since it wasn’t a major election year this year, there wouldn’t be as much attention paid to these issues. This may very well be the case but people need to realize that just because certain topics aren’t being discussed, doesn’t mean they shouldn’t be. And it certainly doesn’t mean they stop being problematic. Since I began my internship in August, all of the following has happened:

Don’t get me wrong, there were also multiple positive things that happened. Unfortunately, any good they may have done for reproductive rights feels negated by the prevailing extremism of anti-abortion activists and politicians. We, as a society, need to do a better job of giving reproductive rights the consistent attention that it deserves and so desperately needs, especially if we ever want to see any real change.


If you would like to contribute to NARAL Pro-Choice NC’s blog, please contact our Advocacy & Organizing Manager at Sarah@ProChoiceNC.org.

Reproductive Rights at Stake in the Supreme Court

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Chavi Koneru, Policy Analyst & Operations Coordinator at NARAL Pro-Choice North Carolina

In 1973, the Supreme Court of the United States made a decision on a case out of Texas that gave women in the United States the right to choose to get an abortion; a decision that women are still fighting to have respected. Forty-three years after Roe v. Wade, the Supreme Court will hear another case out of Texas, one that will also leave a lasting impact on reproductive rights, for better or for worse.

The case, Whole Woman’s Health v. Cole, centers around HB2, a bill passed by the Texas legislature in 2013 that enacted new restrictions for abortion providers. The law required any physician performing an abortion to have admitting privileges at a hospital within 30 miles. It also mandated that abortion clinics meet the building requirements of an ambulatory surgical center including having 8-foot-wide hallways and two janitorial closets; requirements that clearly would have no positive impact on the health or safety of women seeking abortions and were not imposed on any other types of medical procedures.

Represented by the Center for Reproductive Rights, Whole Woman’s Health, along with other clinics, challenged the law based on the undue burden standard established by the Supreme Court in Planned Parenthood v. Casey. In Casey, the Court ruled that any law whose “purpose or effect is to place substantial obstacles in the path of a woman seeking an abortion before the fetus attains viability,” unconstitutionally placed an undue burden on her access to abortion. Whole Woman’s Health’s challenge to HB2 is based on the fact that the regulatory burdens imposed by the law would “dramatically reduce the number and geographic distribution of medical facilities in the State where women can access safe abortion, while providing no benefit to abortion patients whatsoever.” The cost involved with complying with the requirements of HB2 would shut down three-fourths of the clinics in Texas, leaving only 10 abortion clinics available for a state of almost 27 million people.

The Supreme Court’s decision in this case will clearly have an impact on the women of Texas but it will also determine the ability of North Carolina women to access reproductive care. During just the past few years, we have seen several new barriers to abortion access under the guise of protecting women’s health and safety. In fact, the requirements of HB2 might even sound familiar to North Carolinians who remember SB353 passed in 2013, otherwise known as the Motorcycle Vagina law. If the Supreme Court upholds HB2, not only should we expect to see more TRAP (Targeted Regulation of Abortion Providers) laws but we should also expect a wide variety of other deceptive laws that would create higher costs, lengthier delays, and additional obstacles for women seeking abortion care. On the other hand, if the Supreme Court finds HB2 to be unconstitutional, laws such as our recently enacted physician reporting requirements could require a legal determination of whether they cause an undue burden. North Carolina legislators would finally have to answer for all the unjust laws they have put in place to shame women away from utilizing their right to choose.

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While we know that there is a risk that the Supreme Court may put an end to Roe as we know it, there is also the strong hope that this decision will put women several steps closer to being able to fully exercise their right to choose.

The case is likely to be heard in late February or early March with a decision by June. Keep reading the NARAL Pro-Choice North Carolina blog for updates on the case!

Giving Thanks for Birth Control at UNC Chapel Hill

By Abby Kaufmann, NARAL Pro-Choice North Carolina Communications Intern and senior at UNC Chapel Hill

After 3 years at UNC Chapel Hill, I have become very familiar with the general clinic at Campus Health Services but I had never really utilized their Women’s Health Services until this October when I got an intrauterine device (IUD). I am currently interning at NARAL Pro-Choice North Carolina where 10 hours of my week involves researching articles about reproductive justice issues, many of which are about birth control access and affordability. At the time I began the internship, however, I was not on birth control. The risk I was taking really started to nag at me, making anything intimate seem extra nerve-wracking and less enjoyable until I finally decided to do something about it.

A few weeks prior to making the decision to get an IUD, I had to go to campus health multiple times for a cold that just wouldn’t go away. Each time I was there, I couldn’t help but appreciate the free condoms throughout the building and the pamphlets on safe sex that included tips for queer people. But what really caught my attention were the charts on birth control in every exam room I visited, like this one:

I saw that with condoms, my go-to method of birth-control at the time, there was still anywhere between a 2%-18% chance of getting pregnant (depending upon whether or not they are used correctly).  I had tried things like the pill and the NuvaRing in the past but I was always forgetting when to take the pill or when to replace the ring which I knew made them less effective. I decided that an IUD would be the best way to go; not only are IUDs more effective than birth-control pills and the NuvaRing, they last for years.

The first time I heard about an IUD was in a magazine article in 2012. Even then, I recognized the benefits and expressed interest in getting one to my gynecologist in Cary at the time. She didn’t think it was a good idea and successfully scared me into changing my mind. She told me that, since I had never given birth, it would be painful and that this pain was too much for most of her younger clients so she often had to remove their IUDs. She said that the NuvaRing would be my best option since it would be easier to remember and that it was just as effective as an IUD (I now know that both of these statements were false). I expected a similar reaction at Campus Health but was pleasantly surprised to find a wealth of resources about IUDs and to feel supported by both the nurses and the doctors.

I thought I would be able to just show up, have the procedure, and then go about my business for the next 3 years but this was not the case. When you make an appointment to get an IUD at Campus Health Services, you are required to have a brief consultation first so that you can discuss the various types of IUDs and what to expect during the procedure. After that, I also had to make an appointment for a well woman exam so they could check for STDs, do a pap smear, perform a breast exam, and assess my health in general. While it was a little annoying to have to come back so many times, I realized that it was all because Campus Health actually cared about my overall wellbeing. It also provided a good opportunity to get to know the doctor before the procedure.

Usually, CHS prefers to do the procedure when you are menstruating so that they can rule out any chance of pregnancy (even though they do a pregnancy test anyways) because of the life-threatening risks associated with getting an IUD while pregnant. Because of this, some students may have to wait longer than they would like to before they can get their IUD but in the end, it’s really for their own good.

To say that I was impressed with UNC Campus Health Women’s Services would be an understatement. They made sure I felt comfortable about the procedure not only during the procedure itself but before and after it as well. Never once did I feel judged or discouraged from making my decision.

I would encourage my peers to utilize UNC Campus Health’s birth control resources If you attend a different university, don’t be afraid to contact campus health on your campus to see what services they provide. Also, be sure to check out Bedsider for ways to bring birth control to your campus and to compare methods side-by-side.

November is a month for giving thanks and this November, I’m thankful for birth control. And I’m thankful that Campus Health Services at UNC understands that, as college students, we already have so many things to worry about and that getting pregnant doesn’t have to be one. #ThxBirthControl

This post is part of NARAL Pro-Choice North Carolina’s Student Perspectives on Reproductive Justice blog series. To write a post for the series, please contact our advocacy & organizing manager at Sarah@ProChoiceNC.org.